Methodological considerations in selecting male community health workers (CHWs) in farm worker crews

Background: Gaps in the literature exist about the selection and training of community health workers (CHWs). Since 2003 the Florida Prevention Research Center, in partnership with the Farmworker Association of Florida, has selected and trained CHWs for citrus harvesting work crews to promote use of safety glasses. Whereas eye injuries are common in the citrus industry, ironically, few workers (~2%) historically have used protective eyewear because of beliefs that they interfere with harvesting efficiency, thereby adversely influencing wage-earning capability. Objective: This presentation details the methodological challenges and lessons learned from selecting CHWs to assume a role model status of using safety eyewear on citrus harvesting crews. Methods: Field notes recorded by embedded anthropologists documented the CHW selection and training process. Moreover a social network analysis of crews was performed using direct observations, face-to-face interviews with crew leaders and other workers, and examination of archived eye injury reports to inform future selection and training needs of CHWs. Results: Selection of CHWs evolved from a self-selection process to a crew leader selection process; subsequently, the revised process was supplemented with data from field observations and interviews to identify specific desirable CHW traits and qualifications. Furthermore, adoption of safety glasses increased to between 32% and 37% in CHW-led crews. Conclusions: Social network analysis is a useful tool for the selection and training of CHWs. Moreover, use of a systematic process for selecting CHWs for agricultural work crews will increase the chances of workers adopting the targeted behavior.